History
• Purulent or malodorous d/c? Dyspareunia? Pruritus? Postcoital bleeding? Dysuria, urinary frequency or urgency
• RFs: Multiple sexual partners and unprotected intercourse
Physical Exam
• External: Inspect for lesions, ulcerations; adenopathy
• Speculum: Vaginal wall inflammation/d/c; cervical inflammation/d/c
• Bimanual: If cervical motion tenderness or adnexal tenderness, think PID (see below)
Evaluation
• Labs: GC/Chlamydia testing; wet mount
Treatment
• N. gonorrhoeae: Ceftriaxone 125 mg IM × 1
• C. trachomatis: Azithromycin 1 g PO × 1 OR doxycycline 100 mg PO BID × 7 d OR levofloxacin 500 mg PO QD × 7 d
• T. vaginalis: Metronidazole 2 g PO ×1 OR 500 mg PO BID × 7 d
• Bacterial vaginosis metronidazole 500 mg PO BID × 7 d OR metronidazole 0.75% gel intravaginally × 5 d × 1 OR clindamycin 2% cream intravaginally × 7 d
• Candidiasis: Topical azoles (over the counter) × 7 d OR fluconazole 150 mg PO × 1
Pearls
• Educate all pts on safe sex practices
• Advise pts to tell their partners to get tested/treated